| NPI | 1720251200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAQUELIN R WUETHRICH Practice Manager 937-644-8822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 21561) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2017-10-20 |